New with a few questions

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littleorangecat

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Hi. My kitty was just diagnosed one week ago. She also has chronic pancreatitis and asthma. It's a long story, but she has been on pred for a long time and it is the only thing that has controlled either condition (including inhalers). In Nov. she was severely ill with an acute attack of pancreatitis and I almost lost her. I understand that the pred is not ideal for the control of her diabetes but I feel that for now, this is something I have to work with. Additionally, I am unwilling to try a diet change right now since after several different foods, we are on one that seems to be doing okay (yes, it's dry & full of carbs). I want to put this out up front because I don't want you all to think I am ignoring good advice. I just feel that her myriad conditions are very complicated and mean that I have to be very careful in balancing them all.

Her glucose at the vet one week ago was 448. Today it was 437 (+11). She was on 1.25 U Lantus BID. I made the unfortunate mistake of buying the Freestyle Lite which was a whopping 200 points lower than the vet's meter today. The vet wants to up the Lantus to 2 U BID for two weeks and then recheck. I have read "start low and go slow" several times but how slow and low? Is that a reasonable jump for a 12 pound cat? Her pred is also being lowered 25% (from 10mg to 7.5mg). Also, does the new, higher dose take affect immediately or does it have to build up (the shed)? I did go get a Relion today so I will be able to home test. Tonight her +3 is 311. I will start a spreadsheet as soon as I can figure that out :lol:

Thanks,
Little Orange Cat
 
I'm not an expert, but if she is on a high carb dry food I don't know how well SLGS is going to work for you. It takes huge amounts of insulin to counterbalance all the carbs she will be eating and SLGS raises the dose by small increments, very slowly, even slower than TR I believe. Maybe someone will be able to recommend a low carb food that would work for her. In the meantime, I suggest you give catinfo.org a read, it gives a good realistic explanation about why dry food is no good for any cat, even a healthy cat without diabetes.
 
littleorangecat said:
Hi. My kitty was just diagnosed one week ago. She also has chronic pancreatitis and asthma. It's a long story, but she has been on pred for a long time and it is the only thing that has controlled either condition (including inhalers). In Nov. she was severely ill with an acute attack of pancreatitis and I almost lost her. I understand that the pred is not ideal for the control of her diabetes but I feel that for now, this is something I have to work with. Additionally, I am unwilling to try a diet change right now since after several different foods, we are on one that seems to be doing okay (yes, it's dry & full of carbs). I want to put this out up front because I don't want you all to think I am ignoring good advice. I just feel that her myriad conditions are very complicated and mean that I have to be very careful in balancing them all.

Her glucose at the vet one week ago was 448. Today it was 437 (+11). She was on 1.25 U Lantus BID. I made the unfortunate mistake of buying the Freestyle Lite which was a whopping 200 points lower than the vet's meter today. The vet wants to up the Lantus to 2 U BID for two weeks and then recheck. I have read "start low and go slow" several times but how slow and low? Is that a reasonable jump for a 12 pound cat? Her pred is also being lowered 25% (from 10mg to 7.5mg). Also, does the new, higher dose take affect immediately or does it have to build up (the shed)? I did go get a Relion today so I will be able to home test. Tonight her +3 is 311. I will start a spreadsheet as soon as I can figure that out :lol:

Thanks,
Little Orange Cat
Click to expand...

OK let me get the food issue out of the way.
You already know that you will have issues with the high carb dry food; you won't have much luck or an easy time regulating with that food, but we can work with what is being fed now by just giving more insulin. Just remember that when you are ready to switch from high carb dry food to low carb wet food, you are going to see a BIG drop in BG numbers... if LOC is carb sensitive like my Shadoe, the 400s may be the norm if you don't add more insulin to cancel out those carbs. No problem. There are some people who are unable to get their cats to eat the LC wet.

I know everyone is going to be after you to get that sheet up... until you do, just log all your test numbers in a lil' book and then you can populate the sheet later.
You definitely want to test before each shot, and another time just before bed.

I know what the vet wants you to do; it may be an idea to increase a bit slower so that you just leap right over the good dose for LOC. If you are at 1.25u now, maybe try 1.5u and then hold that 1.5u dose for 4-6 shots (2-3 days) and see how her numbers adjust.
As for the shed, yup, any change you make, the shed has to adjust. if you decrease dose, the shed needs to dump the extra, and if you up the dose, the shed needs to be 'topped up'. That's the reason you need to hold a dose for a few days, to be sure the shed is filled and to see if she likes this new dose better. I suggested upping dose to 1.5u so that you can get back on the measure lines of the syringes. If the 1.5u is not enough, you can then go up to a full 2u..... it's alot easier to measure the insulin with lines!

Your test at +3 of 311 is nice to know but the best test is before you give the shot. What if you tested and you got a 65 BG.... you may want to delay the shot. Now imagine if you did not test, but her BG was 65, and you just blindly gave her a normal shot.... you could be reaching for the karo pretty soon if she had a hypo incident.

Now let's get to the pancreatitis. To treat, you need 3 things:
Nausea meds - you can try with just ordinary pepcid AC 10mg tabs. Cut them in 4 and give 1/4 twice a day. Daily max is 5mg for cats.
Pain meds - you need to be giving pain meds for pancreatitis as it's VERY painful, ask any human who has had pancreatitis. Buprenex is pretty common and will def help.
Fluids - giving fluids at home is easy enough to do, give 100cc - 200cc a day depending on what your vet advises is needed.
You treat pancreatitis with nausea meds, pain meds, and fluids.

My Shadoe had frequent problems with pancreatitis, and my new vet said to start giving her B12 shots. I got a vial and gave her shots once a week and now, she rarely has issues. You may want to mention B12 to your vet and see if it's a good idea. You are already giving insulin shots, so giving another one for the B12 is no big deal.

As for the pred and other health issues, I have no experience so I can't comment.

here are some links with info on Hypo issues, what to do, and how to prepare:
List of Hypo symptoms
How to treat HYPOS-They can kill! Print this out!
Jojo’s HYPO TOOLKIT

You may want to pick up some KETOSTIX at the pharmacy so you can test urine for ketones.
Ketones

Finally, here are some food links. Take a look at Binky's list and maybe pick up a couple cans of the LC wet food to be ready to introduce it. It's important to know that there are a great deal of animals who are DIET CONTROLLED so down the road, it may be worth a try to offer a bit of the wet food too.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
List of Low-Carb/Med.-Fat Food for Cats with Diabetes AND Chronic Pancreatitis
 
Here is the link to help you set up a spreadsheet

http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

I agree with Gayle that the increase proposed by your vet is too much. You may end up raising to 2u, or probably more if you're feeding dry food, but you don't want to miss the right dose and put Little Orange Cat at risk of hypo. Lantus dose decisions are made based on the nadir so as well as the preshot tests you want to be getting at least one extra check at the time of nadir. To find out when this is (ECID - every cat is different) you will need to do some curves.

I would also propose an increase to 1.5U and that you hold this dose for three days before making any further changes.

And damn that Freestyle meter (we have nicknamed it the heartbreaker) I made the same mistake and Vyktor ended up with DKA :sad:
 
Vyktors Mum said:
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

I would also propose an increase to 1.5U and that you hold this dose for three days before making any further changes.
Click to expand...

Thank you. I have indeed decided to spend a few days at 1.5U. I will be able to do a curve now that I have the Relion. Thank for the link for setting up a spreadsheet. This is also on the top of my to do list. I am sorry to hear your baby had DKA due to that stupid freestyle :evil:
 
It was horrible, he nearly died. That is also the reason you really need the dipsticks suggested by Gayle, you can get them at the pharmancy and they aren't very expensive. They test urine samples for ketones so you can be aware ASAP if ketones are present and take action quickly in the hopes or warding off a full blown DKA. I was using them but the stupid vet (who did not test Vyktor's blood himself as he should have but also relied on the freestyle readings) said the stix were unreliable and not to worry until there were other symptoms. Little did I know that by the time there are other symptoms it may already be too late. Needless to say that vet is no longer part of Vyktor's life!

LOC's readings are high enough at the moment that ketones are a possibility so I would get onto this quickly if I were you. If you need any help with how to get a urine sample post a new thread here with that question and people will help you out with a range of ideas.
 
Vyktors Mum said:
LOC's readings are high enough at the moment that ketones are a possibility so I would get onto this quickly if I were you. If you need any help with how to get a urine sample post a new thread here with that question and people will help you out with a range of ideas.
Click to expand...

Thanks to both you and Gayle for the suggestion. I did buy some and will attempt to get a sample as soon as possible.
 
Gayle Shadoe & Oliver said:
littleorangecat said:
I got a spreadsheet started. Thanks :)

https://docs.google.com/spreadsheet/ccc?key=0Al0UdBWmeX5HdHNsdm9zN3JPZ1hfUHZ5N3Y3REVTZ1E
Click to expand...

Good going! The sheet is up and viewable! Well done!
Now, LOC's numbers can be seen and you can get some good feedback.

Make sure you get the test numbers before each shot so you know it's safe to shoot.
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I will, thank you. And since I didn't answer you earlier, I do have all the pancreatitis meds you suggested at home and at the ready should she need them again. We've been doing pretty well for a few weeks (YAY).
 
Hi,

Great job at getting your ss up already!

You said you tried aerosols. I'm wondering if you tried the Aerokat with Flovent or Flixotide 250 for Littleorangecat's asthma? It worked wonders for Racci. She takes 1puff Flixotide/Flovent 250 bid and has had only 1 attack in 2 years. For Emergencies and when she started, I used a brochiodilater, Albuterol, before the Flovent and still keep it handy for attacks. It takes a few weeks for the Flovent to start working so she took prednisolone for that short time and then weened off it and the Flovent was working well enough on its own by then. It was truly a miracle for Racci and so many other cats that were able to get off pred. Of course there are always some that have it so severely that they needed pred anyway. I don't know if that's the case with your fur baby or not but if you haven't gone this route or given it a real try, it's certainly worth it. Some cats develop diabetes from the pred and as soon as its stopped, can have a remission within weeks.

Melanie & Racci
 
littleorangecat said:
Hi. My kitty was just diagnosed one week ago. She also has chronic pancreatitis and asthma. I understand that the pred is not ideal for the control of her diabetes but I feel that for now, this is something I have to work with. Additionally, I am unwilling to try a diet change right now since after several different foods, we are on one that seems to be doing okay (yes, it's dry & full of carbs). I just feel that her myriad conditions are very complicated and mean that I have to be very careful in balancing them all.
Click to expand...

I had similar issues to deal with. Boo was not asthmatic but he did have chronic pancreatitis which definitely complicates the situation. He was also on steroids because it was the only thing that kept the pancreatitis controlled. If you've found a food that works with her system, you're better off sticking with it and working the insulin around it. There have been people here who have managed to regulate their diabetics on dry food. It's not an impossible situation. There have even been several cats who went into remission on a dry food diet. Cats with chronic pancreatitis need to have that condition cared for first and then have the diabetes treatment tailored to fit. There have been a number of posters here who did have more success using lower fat foods for pancreatitis. My Boo liked canned food but he had to have the higher carb foods in gravy because the other ones were too high in fat for him to handle. Despite being on a high carb diet and steroids, we managed to maintain very good glucose control on a dose of 5-6 units.

littleorangecat said:
The vet wants to up the Lantus to 2 U BID for two weeks and then recheck. I have read "start low and go slow" several times but how slow and low? Is that a reasonable jump for a 12 pound cat? Her pred is also being lowered 25% (from 10mg to 7.5mg).
Click to expand...

When Boo was first diagnosed, he was in DKA. After we got him over that and got him eating again, his levels zoomed up to the high 500's. Because of his history with DKA, we were a bit more aggressive with his dosing. His lowest point of the day was still over 300 so there wasn't too much fear of him dropping too low. I think we did full unit increases from 1-2 units and again from 2-3. When we saw his overall numbers coming down, we dropped back to half unit increases. If you do decide to increase by a full unit, just make sure that you have enough data to base it on and always make that initial increase on a day when you will be home and can monitor throughout the day.

Also, I would be careful about lowering the pred. If you start to see symptoms of either the asthma or pancreatitis coming back, I would go back to the current dose. We tried to wean Boo off of the steroids a few times and it never worked. Finally, I just gave in to the fact that this was how we had to manage his care to give him the best quality of life. He actually had better numbers on steroids than he did without them. He needed to be immunosuppressed in order to keep that pancreatitis under control.
 
I also wanted to say that while Racci never had pancreatitis, she is a dry food junkie and in love with that horrible Purina DM. She did finally become regulated after several years free feeding with a dose of 4.5 and 5U. She is almost 20 lbs though. I have been trying to get her on canned food all this time, every now and then, even cooking for her. This is the longest stretch of trying and instead of going down, her numbers are going up again so I may just have to give up and put her back on her dm. She is over 15 and just may not be able to change or handle the sodium and fat in the canned and she is not eating enough. You may have to use similar high doses on the dry food. I went up by half units though over a long stretch of time.

Melanie & Racci
 
MelanieAndRacci said:
You said you tried aerosols. I'm wondering if you tried the Aerokat with Flovent or Flixotide 250 for Littleorangecat's asthma? It worked wonders for Racci. She takes 1puff Flixotide/Flovent 250 bid and has had only 1 attack in 2 years. For Emergencies and when she started, I used a brochiodilater, Albuterol, before the Flovent and still keep it handy for attacks. It takes a few weeks for the Flovent to start working so she took prednisolone for that short time and then weened off it and the Flovent was working well enough on its own by then.
Click to expand...

Yes, we do have the Aerokat and tried to use Flovent to control the asthma with very limited success. My vet and I were trying out Atopica to control the asthma (and I do believe it was working) but as we lowered the pred her pancreas flared up with her worst attack ever. Since the pred had to be upped anyway for the pancreas, we discontinued the Atopica since her asthma was just fine. This is the short version of these stories, but unfortunately it seems that the pred is about the only thing her body seems to respond to as far as keeping these issues under control.
 
Oh, I see. You needed it more for the pancreatitis than the asthma. I'm glad at least the asthma is under control. The poor kits suffer so much, it's just not fair! I never heard of the Atopica. Is that a bronchodilator or an inhaled steroid like Flovent? I found with Flovent I had to go to the higher dose of 250 to get absolute control. It doesn't really matter though if you have to use the pred anyway. I was just curious if that might be something that would help but I guess not.

Melanie & Racci
 
Deanie and Boo (GA) said:
I had similar issues to deal with. Boo was not asthmatic but he did have chronic pancreatitis which definitely complicates the situation. He was also on steroids because it was the only thing that kept the pancreatitis controlled. If you've found a food that works with her system, you're better off sticking with it and working the insulin around it. There have been people here who have managed to regulate their diabetics on dry food. It's not an impossible situation. There have even been several cats who went into remission on a dry food diet. Cats with chronic pancreatitis need to have that condition cared for first and then have the diabetes treatment tailored to fit. There have been a number of posters here who did have more success using lower fat foods for pancreatitis. My Boo liked canned food but he had to have the higher carb foods in gravy because the other ones were too high in fat for him to handle. Despite being on a high carb diet and steroids, we managed to maintain very good glucose control on a dose of 5-6 units.
Click to expand...

Thank you. I would honestly be terrified to try a new food right now with the level of severity of her last attack just a few weeks ago. I did try lower fat foods without much success. I tried hydrolyzed proteins, novel proteins, low fat, and right now she seems to be doing well with low-residue. She previously was on a high protein canned diet for about 4-5 weeks prior to her first attack of pancreatitis so I have been a little wary. She is also a dry food addict, and the only part of canned food she seems to like is the liquid that runs around the edge of the can. God forbid you give her anything chunky or shredded.

Deanie and Boo (GA) said:
Also, I would be careful about lowering the pred. If you start to see symptoms of either the asthma or pancreatitis coming back, I would go back to the current dose. We tried to wean Boo off of the steroids a few times and it never worked. Finally, I just gave in to the fact that this was how we had to manage his care to give him the best quality of life. He actually had better numbers on steroids than he did without them. He needed to be immunosuppressed in order to keep that pancreatitis under control.
Click to expand...

I really appreciate this comment. I have been very anti-pred but have also resigned myself to the fact that if it is the only thing giving her a good quality of life then that is what I have to work with. If I see even a flicker of a problem I will be upping that dose and I believe that her vet will also be in agreement on this.

MelanieAndRacci said:
Oh, I see. You needed it more for the pancreatitis than the asthma. I'm glad at least the asthma is under control. The poor kits suffer so much, it's just not fair! I never heard of the Atopica. Is that a bronchodilator or an inhaled steroid like Flovent? I found with Flovent I had to go to the higher dose of 250 to get absolute control. It doesn't really matter though if you have to use the pred anyway. I was just curious if that might be something that would help but I guess not.
Click to expand...

Atopica is an oral med that suppresses the immune system. It is not a first line treatment and can be kind of expensive (but I do think it worked). The asthma is controlled at the higher (5mg BID) of pred, but as soon as it gets to around half that the asthma definitely comes back. Since we have had to have the pred upped for so long, the asthma has become less of an issue.
 
Atopica is an oral med that suppresses the immune system. It is not a first line treatment and can be kind of expensive (but I do think it worked). The asthma is controlled at the higher (5mg BID) of pred, but as soon as it gets to around half that the asthma definitely comes back. Since we have had to have the pred upped for so long, the asthma has become less of an issue.
Click to expand...

Thanks for the info. Yes, I know what you mean about cutting meds. Every time I fool myself into thinking that Racci's asthma is better, and stop the Flovent, she has an attack. I stopped experimenting and just buy them 3 at a time from Canada and they're much cheaper that way for the same medicine.

Melanie & Racci
 
Deanie and Boo (GA) said:
If you do decide to increase by a full unit, just make sure that you have enough data to base it on and always make that initial increase on a day when you will be home and can monitor throughout the day.
Click to expand...

Because of the shed action of Lantus you do not see the full effect (or often any effect) of a new dose on the next cycle, you may not see the full effect for up to a week.
 
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